Anaesthetic management and unplanned admission to intensive care after thoracic surgery

Licker, Marc

doi:10.1111/anae.14741

Cited by 7 publications

(6 citation statements)

References 29 publications

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“…Fourthly, this study primarily aimed to analyze the expert opinions of thoracic anesthesiologists on the anesthesia care and ventilatory support during thoracic surgery requiring OLV. Other unexpected perioperative adverse events such as surgical-related injury, severe bleeding, unstable hemodynamics, hypothermia, delirium or drug-responses [33] that could influence the general outcomes of thoracic surgeries were not taken into consideration in this report. Lastly, these results might not be completely representative of the expert opinions of all the Taiwanese thoracic anesthesiologists, as some medical centers and other regional hospitals were not included in our study.…”

Section: Discussionmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

et al. 2020

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Background There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6–7 ml/kg PBW (67.6%) and a PEEP level of 4–6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 > 0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

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Section: Discussionmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

et al. 2020

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show abstract

“…this study primarily aimed to analyze the expert opinions of thoracic anesthesiologists on the anesthesia care and ventilatory support during thoracic surgery requiring OLV. Other unexpected perioperative adverse events such as surgical-related injury, severe bleeding, unstable hemodynamics, hypothermia, delirium or drug-responses [33] that could in uence the general outcomes of thoracic surgeries were not taken into consideration in this report. Lastly, these results might not be completely representative of the expert opinions of all the Taiwanese thoracic anesthesiologists, as some medical centers and other regional hospitals were not included in our study.…”

Section: Discussionmentioning

confidence: 99%

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

Kuo

Liu

Chen

et al. 2020

Preprint

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Background: There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods: This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results: A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6-7 ml/kg PBW (67.6%) and a PEEP level of 4-6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 >0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions: This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

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“…Many of the observed themes the authors described resonated with us, in particular the observation of the significant impact of non-clinical commitments. The further discussion around the allocation of designated supporting professional activities (SPA) time for trainees is an idea that we would support, as has also been discussed in the recent Royal College of Anaesthetists report on the topic [3]. We await with interest the new anaesthetic curriculum and its guidance on this, even though the challenge of maintaining adequate clinical training time is clearly an important factor.…”

Section: Association Between Anaesthetic Technique and Unplanned Admimentioning

confidence: 95%

“…Throughout our narrative, however, we have gone to some lengths to highlight that while 'thought provoking', our findings are of association, not causation, and we must therefore be careful not to over-interpret the results. As Licker describes in his accompanying editorial [3], 'the Achilles heel of observational studies is the presence of confounding factors related to population characteristics, as well as to treatment and outcomes'. We quite agree with both commentators; there is no doubt that there are many potential confounders which might have influenced our findings.…”

Section: Association Between Anaesthetic Technique and Unplanned Admimentioning

confidence: 99%

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Association between anaesthetic technique and unplanned admission to intensive care after thoracic lung resection surgery: a reply

2020

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Anaesthetic management and unplanned admission to intensive care after thoracic surgery

Cited by 7 publications

References 29 publications

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

Association between anaesthetic technique and unplanned admission to intensive care after thoracic lung resection surgery: a reply

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